A Rising Concern: The Increasing Mortality Rates from Falls Among Seniors

In recent years, the act of walking a dog has transformed from a simple pleasure into a potential hazard for many seniors. Earl Vickers, a 69-year-old retired electronic engineer from Seaside, California, experienced this firsthand. His beloved dog, Molly, a mix of German Shepherd and Boxer, used to accompany him on walks along the beach and through the neighborhood. However, Vickers began to face significant challenges when he started to lose his balance, leading to frequent falls.

The Personal Toll of Falls

Vickers recalls, “Every time another dog approached us, I ended up on the ground.” His falls were frequent enough that he felt he was tumbling every couple of months. While most incidents did not result in severe injuries, one fall left him with a concussion-like injury after hitting his head against a wall. Another time, he fractured two bones in his left hand while trying to break his fall.

In 2022, after consulting with his oncologist about his prostate cancer treatment, Vickers made a pivotal decision to stop taking enzalutamide, a medication linked to increased fall risks. “I haven’t fallen once since then,” he noted, highlighting the profound impact that medication can have on physical stability.

The Alarming Statistics

Public health experts have long warned about the dangers of falls for older adults. According to the Centers for Disease Control and Prevention (CDC), over 41,000 individuals aged 65 and older died from falls in 2023. This figure is not just a statistic; it represents a growing trend. Thomas Farley, an epidemiologist, pointed out in a recent opinion piece in JAMA Health Forum that mortality rates related to falls among seniors have tripled over the past three decades. For those aged 85 and older, the mortality rate surged from 92 per 100,000 in 1990 to 339 per 100,000 in 2023.

The Role of Medications

Farley attributes this alarming increase to the rising dependence on prescription medications among older adults. “Seniors are increasingly overmedicated with drugs that are often inappropriate for their age,” he stated in an interview. This trend is not observed in countries like Japan or those in Europe, where the rates of fall-related deaths have not seen similar spikes.

Despite numerous initiatives aimed at reducing falls and their severe consequences-such as hip fractures and loss of mobility-efforts have not yielded the desired results. The American Geriatrics Society updated its fall prevention guidelines in 2011, and the CDC launched the STEADI program in 2012. Yet, as Donovan Maust, a geriatric psychiatrist at the University of Michigan, noted, “Despite studies and interventions, the problem seems to be worsening.”

A Complex Issue

While Farley emphasizes the role of medications, many experts in geriatrics remain skeptical about attributing the rise in fall-related deaths solely to prescription drugs. Factors such as physical decline, vision loss, alcohol consumption, and home hazards also contribute to falls. Farley acknowledged that these elements have not worsened significantly over the past 30 years, suggesting that the increase in medication use in the U.S. is a critical factor.

Certain medications, particularly those affecting the central nervous system, have been identified as particularly problematic. These include benzodiazepines, opioids, antidepressants, and gabapentin. Collectively known as FRIDs (fall-risk-increasing drugs), they can significantly elevate the risk of falls among older adults.

The Debate on Reporting and Health Changes

Thomas Gill, a geriatrician and epidemiologist at Yale University, agrees that while medications play a role, other explanations must also be considered. He pointed out that the way causes of death are reported has changed over the years. In the past, falls were often seen as a natural consequence of aging, with death certificates attributing fatalities to underlying health conditions rather than the falls themselves.

Moreover, Gill noted that today’s seniors, particularly those over 85, may be more fragile and suffer from multiple health issues compared to their counterparts three decades ago. Advances in medicine have allowed people to live longer, but this can also mean that they are more susceptible to severe outcomes following a fall.

A Shift in Medical Practice

Neil Alexander, a geriatrician at the University of Michigan, argues that many healthcare providers are now more aware of the risks associated with FRIDs and are prescribing them less frequently. “The message has been received,” he stated, noting that the alarm surrounding opioid and benzodiazepine use has led to more cautious prescribing practices.

Interestingly, while prescriptions for opioids and benzodiazepines have decreased, the use of antidepressants and gabapentin has risen. This shift raises questions about whether the increase in fall-related deaths can be attributed to these newer medications.

The Call for Deprescribing

Regardless of the specific causes, there is a growing consensus that many medications are overprescribed and may do more harm than good for older adults. This has led to a movement advocating for “deprescribing,” which involves reducing or stopping medications that pose more risks than benefits.

Michael Steinman, a geriatrician at the University of California, San Francisco, emphasized the importance of addressing the issue. “Many of these medications can increase the risk of falls by 50 to 75% in older adults,” he explained.

Steinman encourages seniors to engage in conversations with their healthcare providers about their medications, particularly regarding FRIDs. “Ask your doctor, ‘Does any of my medication increase my risk of falls? Are there alternative treatments?'” he advised.

Conclusion

The rising mortality rates from falls among older adults present a complex challenge that intertwines medication use, health reporting practices, and the natural aging process. As the healthcare community continues to grapple with this issue, it is crucial for seniors and their caregivers to remain informed and proactive about their health. By fostering open dialogues with healthcare providers and advocating for safer medication practices, there is hope for reducing the alarming trend of fall-related deaths in this vulnerable population.